The Nurse-Family Partnership Model Improves Maternal and Child Health in Louisiana
Historically, staff within the Louisiana Department of Health and Hospitals, Office of Public Health, in partnership with the Tulane School of Medicine’s Department of Psychiatry and Behavioral Sciences, have sought to implement an evidence-based intervention that would address poor maternal and child health outcomes in the state. In 1999, the Louisiana Office of Public Health began implementation of the Nurse-Family Partnership (NFP) model, a home visitation program for low income, first-time pregnant mothers and their babies. This model had been rigorously researched, via large scale randomized controlled trials, showing effectiveness in advancing maternal and child health. Results from the trials in Elmira, New York (1977), Memphis, Tennessee (1990), and Denver, Colorado (1994), revealed improved prenatal health; fewer injuries during childhood; fewer subsequent pregnancies and greater intervals between births; increased maternal employment; and increased school readiness.1 Following the initial implementation in 1999, Louisiana NFP program grew considerably. Beginning with 2 teams in 7 parishes, it has expanded to 16 teams currently serving 59 of Louisiana’s 64 parishes.
With NFP, every first-time mom partners with a registered nurse, who provides support during home visits throughout her pregnancy and until the child reaches 2 years of age. NFP home visitors have 3 main goals: to help moms engage in preventive health practices like prenatal care and reduce the use of cigarettes, alcohol, and illegal substances; to ensure healthy infant/toddler growth and development; and to help moms become more economically self-sufficient. Since its inception, NFP in Louisiana has served more than 15,000 families. Based on cumulative data as of June 2014, NFP clients experienced an 18% reduction in smoking during pregnancy and a 24% increase in workforce participation among those 18 years and older, and 92% of 24-month-olds had been fully immunized.2
Early on, Louisiana NFP home visitors found that many clients needed mental health services, but were unable to find a provider due to the limited mental health services available for low-income pregnant women and very young children across the state. Drawing on the recognition of need and the locally available expertise in perinatal and infant/early childhood mental health, Louisiana began augmentation of the NFP model by adding Infant Mental Health Specialists (IMHSs). IMHSs provided NFP teams with case consultation, direct behavioral health services for mothers and their young children, and support to the team supervisors and nurse home visitors who are working with families with complex mental health needs and problems in parent-child relationships. To further assess the mental health needs of families and to inform the development of the augmentation, in 2011 NFP staff conducted a review of the initial depression screens of pregnant NFP mothers, finding that almost 22% reported clinically significant depression symptoms and 25% of mothers identified 4 or more mental health risk factors that can impact parenting. Currently, 7 NFP teams have an IMHS, and an expansion to include an IMHS on every NFP team is underway.
Preliminary evaluation results for the IMHS augmentation of the model indicate that the IMHS’s role is valued by NFP staff and is contributing to positive outcomes for the families who are served.3,4 Going forward, NFP staff will continue to evaluate the addition of IMHSs as part of the model to determine the impact of this component on clients and NFP teams and to inform how this augmentation should be included in evidence-based early maternal and childhood home visiting. Louisiana will continue to implement and evaluate the NFP home visiting model, with the expansion of IMHSs to all teams, to improve maternal and child health outcomes and address gaps in their health care system, including access to mental health.
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